Management of acute otitis media in an era of increasing antibiotic resistance

Development of resistance to available antimicrobial agents has been identi fied in every decade since the introduction of the sulfonamides in the 1930 s. Current concerns for management of acute otitis media (AOM) are multi-dr ug resistant Streptococcus pneumoniae and beta-lactamase producing Haemophi lus influenzae and Moraxella catarrhalis. In the USA, amoxicillin remains t he drug for choice for AOM. Increasing the current dose to 80 mg/kg/day in two doses provides increased concentrations of drug in serum and middle ear fluid and captures additional resistant strains of S. pneumoniae. For chil dren who fail initial therapy with amoxicillin an expert panel convened by the Centers for Disease Control and Prevention suggested amoxicillin-clavul anate, cefuroxime axetil or intramuscular ceftriaxone. To protect the thera peutic advantage of antimicrobial agents used for AOM, it is important to p romote judicious use of antimicrobial agents and avoid uses if it is likely that viral infections are the likely cause of the disease, to implement pr ograms for parent education and to increase the accuracy of diagnosis of AO M, Conjugate polysaccharide pneumococcal vaccines are currently in clinical trial; early results indicate protective levels of antibody can be achieve d with a three dosage schedule beginning at 2 months of age. Finally, alter native medicine remedies may be of value for some infectious diseases inclu ding AOM; garlic extract is bactericidal for the major bacterial pathogens of AOM but is heat- and acid-labile and loose activity when cooked or taken by mouth. (C) 1999 Elsevier Science Ireland Ltd. All rights reserved.